Risk environments facing potential users of a supervised injection site in Ottawa, Canada

Harm Reduction Journal

Mark Tyndall²  Sheetal Patel⁴  Caleb Chepesiuk⁴  Daina Stanley⁴  Dolly Lin¹  Sean LeBlanc⁵  Tyler Pantalone³  Lisa Lazarus⁴  Ashley Shaw⁴ 

[1] Department of Medicine, University of Ottawa, 451 Smyth Rd., Ottawa K1H 8M5, Ontario, Canada;University of Ottawa at The Ottawa Hospital, Division of Infectious Disease, 501 Smyth Rd., Ottawa K1H 8L6, ON, Canada;PROUD Committee, 85 Primrose Ave., Ottawa K1R 6M1, Ontario, Canada;Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa K1Y 4E9, Ontario, Canada;Drug Users Advocacy League, 216 Murray St., Ottawa K1N 5N1, ON, Canada

关键词: Community-based research;    Marginalized populations;    Service users;    Injection drug use;    Harm reduction;    Supervised injection;   

Others  :  1232287
DOI  :  10.1186/s12954-015-0083-9

 received in 2015-06-25, accepted in 2015-10-13,  发布年份 2015

【 摘 要 】

Background

Supervised injection sites (SISs) have been effective in reducing health risks among people who inject drugs (PWID), including those who face issues of homelessness, mental health illness, interactions with local policing practices, and HIV infection. We investigate the risk behaviours and risk environments currently faced by potential users of an SIS in Ottawa to establish the need for such a service and to contribute to the design of an SIS that can address current health risks and reduce harm.

Methods

The PROUD cohort is a community-based participatory research (CBPR) project that examines the HIV risk environment among people who use drugs in Ottawa. From March to October 2013, 593 people who reported using injection drugs or smoking crack cocaine were enrolled through street-based recruitment in the ByWard Market neighbourhood, an area of the city with a high concentration of public drug use and homelessness. Participants completed a demographic, behavioural, and risk environment questionnaire and were offered HIV point-of-care testing. We undertook descriptive and univariate analyses to estimate potential use of an SIS by PWID in Ottawa and to explore risk behaviours and features of the risk environment faced by potential users of the service.

Results

Of those participants who reported injecting drugs in the previous 12 months (n = 270), 75.2 % (203) reported a willingness to use an SIS in Ottawa. Among potential SIS users, 24.6 % had recently injected with a used needle, 19.0 % had trouble accessing new needles, 60.6 % were unstably housed, 49.8 % had been redzoned by the police, and 12.8 % were HIV positive. Participants willing to use an SIS more frequently injected in public (OR = 1.98, 95 % CI = 1.06–3.70), required assistance to inject (OR = 1.84, 95 % CI = 1.00–3.38), were hepatitis C positive (OR = 2.13, 95 % CI = 1.16–3.91), had overdosed in the previous year (OR = 2.00, 95 % CI = 1.02–3.92), and identified as LGBTQ (OR = 5.61, 95 % CI = 1.30–24.19).

Conclusion

An SIS in Ottawa would be well-positioned to reach its target group of highly marginalized PWID and reduce drug-related harms. The application of CBPR methods to a large-scale quantitative survey supported the mobilization of communities of PWID to identify and advocate for their own service needs, creating an enabling environment for harm reduction action.

【 授权许可】

   
2015 Shaw et al.

【 参考文献 】

• [1]Navarro C, Leonard L. Prevalence and factors related to public injecting in Ottawa, Canada: implications for the development of a trial safer injecting facility. Int J Drug Policy. 2004; 15(4):275-84.
• [2]Islam MM, Topp L, Day CA, Dawson A, Conigrave KM. The accessibility, acceptability, health impact and cost implications of primary healthcare outlets that target injecting drug users: a narrative synthesis of literature. Int J Drug Policy. 2012; 23(2):94-102.
• [3]Laupland KB, Embil JM. Reducing the adverse impact of injection drug use in Canada. Can J Infect Dis Med Microbiol. 2012; 23(3):106-7.
• [4]What is harm reduction? A position statement from the International Harm Reduction Association. London, United Kingdom: International Harm Reduction Association; 2009. http://www.ihra.net/what-is-harm-reduction. Accessed 7 Apr 2014.
• [5]Murphy P, Sales P, Choe J, McKearin G, Murphy S. The dynamics of needle exchange and other service provision. American Society of Criminology meeting, San Francisco, CA; 2000.
• [6]Small W, Wood E, Lloyd-Smith E, Tyndall M, Kerr T. Accessing care for injection-related infections through a medically supervised injecting facility: a qualitative study. Drug Alcohol Depend. 2008; 98(1):159-62.
• [7]Wood E, Tyndall MW, Zhang R, Montaner JSG, Kerr T. Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction. 2007; 102(6):916-9.
• [8]Potier C, Laprévote V, Dubois-Arber F, Cottencin O, Rolland B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend. 2014; 145:48-68.
• [9]Broadhead RS, Kerr TH, Grund JPC, Altice FL. Safer injection facilities in North America: their place in public policy and health initiatives. J Drug Issues. 2002; 32(1):329-55.
• [10]Hedrich D, Kerr T, Dubois-Arber F. Drug consumption facilities in Europe and beyond. In: Rhodes T, Hedrich D, editors. Harm reduction: evidence, impacts and challenges. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Scientific Monograph Series. 2010;10:p.305. doi:10.2810/29497.
• [11]Marshall BDL, Milloy MJ, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011; 377(9775):1429-37.
• [12]Salmon AM, van Beek I, Amin J, Kaldor J, Maher L. The impact of a supervised injecting facility on ambulance call-outs in Sydney. Australia Addict Abingdon Engl. 2010; 105(4):676-83.
• [13]Kimber J, Dolan K, Wodak A. Survey of drug consumption rooms: service delivery and perceived public health and amenity impact. Drug Alcohol Rev. 2005; 24(1):21-4.
• [14]Wood E, Tyndall MW, Lai C, Montaner JSG, Kerr T. Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Subst Abuse Treat Prev Policy. 2006; 1(1):13. BioMed Central Full Text
• [15]Freeman K, Jones CGA, Weatherburn DJ, Rutter S, Spooner CJ, Donnelly N. The impact of the Sydney Medically Supervised Injecting Centre (MSIC) on crime. Drug Alcohol Rev. 2005; 24(2):173-84.
• [16]Millson P, Leonard L, Remis R, Strike C, Challacombe L. Injection drug use, HIV and HCV infection in Ontario: The evidence 1992–2004. HIV Social, Behavioural and Epidemiological Studies Unit, Faculty of Medicine, University of Toronto, Toronto; 2005. http://www.health.gov.on.ca/english/providers/pub/aids/reports/injection_druguse_hiv_hcv_infection_ontario_evi.pdf. Accessed Jan 23 2013.
• [17]Pilon R, Leonard L, Kim J, Vallee D, De Rubeis E, Jolly AM et al.. Transmission patterns of HIV and hepatitis C virus among networks of people who inject drugs. PLoS ONE. 2011; 6(7):1-7.
• [18]Bayoumi A, Strike C, Brandeau M, Degani N, Fischer B, Glazier R, et al. Report of the Toronto and Ottawa Supervised Consumption Assessment Study, 2012. St. Michael’s: University of Toronto; 2012. http://www.catie.ca/en/resources/report-toronto-and-ottawa-supervised-consumption-assessment-study-2012. Accessed 23 Jan 2013.
• [19]Leonard L, DeRubeis E, Strike C. Needs assessment for a safer injecting facility in Ottawa, Canada. Ottawa, ON: University of Ottawa; 2008. http://www. researchgate.net/publication/255683793_Needs_Assessment_for_a_Safer_Injecting_Facility_in_Ottawa_Canada webcite
• [20]Rhodes T. The risk environment: a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002; 13(2):85-94.
• [21]Goldenberg SM, Strathdee SA, Gallardo M, Nguyen L, Lozada R, Semple SJ et al.. How important are venue-based HIV risks among male clients of female sex workers? A mixed methods analysis of the risk environment in nightlife venues in Tijuana. Mexico Health Place. 2011; 17(3):748-56.
• [22]Richardson L, Wood E, Kerr T. The impact of social, structural and physical environmental factors on transitions into employment among people who inject drugs. Soc Sci Med. 2013; 76(1):126-33.
• [23]Minkler M, Wallerstein N. Community-based participatory research for health: from process to outcomes. John Wiley & Sons, San Francisco, CA; 2010.
• [24]Rhodes T. Risk environments and drug harms: a social science for harm reduction approach. Int J Drug Policy. 2009; 20(3):193-201.
• [25]Rhodes SD, Malow RM, Jolly C. Community-based participatory research (CBPR): a new and not-so-new approach to HIV/AIDS prevention, care, and treatment. AIDS Educ Prev. 2010; 22(3):173.
• [26]Minkler M. Community-based research partnerships: challenges and opportunities. J Urban Health. 2005; 82(2):ii3-12.
• [27]Lazarus L, Shaw A, LeBlanc S, Martin A, Marshall Z, Weersink K et al.. Establishing a community-based participatory research partnership among people who use drugs in Ottawa: the PROUD cohort study. Harm Reduct J. 2014; 11(1):26. BioMed Central Full Text
• [28]What is being done about discarded needles in our communities? Ottawa Public Health. http://ottawa.ca/en/residents/public-health/healthy-living/what-being-done-about-discarded-needles-our-communities. Accessed 24 Jan 2013.
• [29]DeBeck K. The validity of reporting willingness to use a supervised injecting facility on subsequent program use among people who use injection drugs. Am J Drug Alcohol Abuse. 2012; 38(1):55-62.
• [30]Patrick DM, Tyndall MW, Cornelisse PGA, Li K, Sherlock CH, Rekart ML et al.. Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection. Can Med Assoc J. 2001; 165(7):889-95.
• [31]Kerr T, Tyndall M, Li K, Montaner J, Wood E. Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005; 366(9482):316-8.
• [32]Shannon K, Rusch M, Morgan R, Oleson M, Kerr T, Tyndall MW. HIV and HCV prevalence and gender-specific risk profiles of crack cocaine smokers and dual users of injection drugs. Subst Use Misuse. 2008; 43(3–4):521-34.
• [33]Kerr T, Fairbairn N, Tyndall M, Marsh D, Li K, Montaner J et al.. Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users. Drug Alcohol Depend. 2007; 87(1):39-45.
• [34]Buxton JA, Skutezky T, Tu AW, Waheed B, Wallace A, Mak S. The context of illicit drug overdose deaths in British Columbia, 2006. Harm Reduct J. 2009; 6:9. BioMed Central Full Text
• [35]Jozaghi E, Reid AA, Andresen MA, Juneau A. A cost-benefit/cost-effectiveness analysis of proposed supervised injection facilities in Ottawa. Canada Subst Abuse Treat Prev Policy. 2014; 9(1):31. BioMed Central Full Text
• [36]Fairbairn N, Small W, Van Borek N, Wood E, Kerr T. Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study. Harm Reduct J. 2010; 7(1):20. BioMed Central Full Text
• [37]Small W, Rhodes T, Wood E, Kerr T. Public injection settings in Vancouver: physical environment, social context and risk. Int J Drug Policy. 2007; 18(1):27-36.
• [38]Rhodes T, Kimber J, Small W, Fitzgerald J, Kerr T, Hickman M et al.. Public injecting and the need for “safer environment interventions” in the reduction of drug-related harm. Addiction. 2006; 101(10):1384-93.
• [39]Wood E, Kerr T, Small W, Li K, Marsh DC, Montaner JSG et al.. Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Can Med Assoc J. 2004; 171(7):731-4.
• [40]McKnight I, Maas B, Wood E, Tyndall MW, Small W, Lai C et al.. Factors associated with public injecting among users of Vancouver’s supervised injection facility. Am J Drug Alcohol Abuse. 2007; 33(2):319-25.
• [41]Duff C. The drifting city: the role of affect and repair in the development of “Enabling Environments.”. Int J Drug Policy. 2009; 20(3):202-8.
• [42]Fairbairn N, Milloy M-J, Zhang R, Lai C, Grafstein E, Kerr T et al.. Emergency department utilization among a cohort of HIV-positive injecting drug users in a Canadian setting. J Emerg Med. 2012; 43(2):236-43.
• [43]Reddon H, Wood E, Tyndall M, Lai C, Hogg R, Montaner J et al.. Use of North America’s first medically supervised safer injecting facility among HIV-positive injection drug users. AIDS Educ Prev. 2011; 23(5):412-22.
• [44]Johnston LG, Whitehead S, Simic-Lawson M, Kendall C. Formative research to optimize respondent-driven sampling surveys among hard-to-reach populations in HIV behavioral and biological surveillance: lessons learned from four case studies. AIDS Care. 2010; 22(6):784-92.